OVERDOSE EDUCATION & NALOXONE DISTRIBUTION (OEND) IN MICHIGAN P A M E L A L Y N C H, L L M S W, C A A D C W H O S O E V E R C O L L A B O R A T I V E

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1 OVERDOSE EDUCATION & NALOXONE DISTRIBUTION (OEND) IN MICHIGAN P A M E L A L Y N C H, L L M S W, C A A D C W H O S O E V E R C O L L A B O R A T I V E

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3 Sales of opioids: Michigan is above the median in kilograms per 10,000 residents (2010 data)

4 Misuse of OPIOIDS in the Past Year among Persons Aged 12 or Older, by Substate Region: Percentages, Annual Averages Based on 2008, 2009, and 2010 NSDUHs

5 ALCOHOL: LEGAL, SOCIALLY ACCEPTABLE, DESTRUCTIVE ALTERNATIVE

6 EVERY NEVER I EVER SAID CAME TRUE : PATHWAYS FROM PAINKILLERS TO HEROIN D A N I E L C I C C A R O N E M D, M P H, * S A R A H M A R S P H D,* P H I L I P P E B O U R G O I S P H D, * * F E R N A N D O M O N T E R O, * * G E O R G E K A R A N D I N O S, * * * U N I V E R S I T Y O F C A L I F O R N I A S A N F R A N C I S C O * * U N I V E R S I T Y O F P E N N S Y L V A N I A

7 MICHIGAN DEATHS Half Wayne County, half out-state Decedents are a mix of pain patients and drug users. Patient and prescriber errors with potent opioids have led to deaths. Cocaine & Opiates Cocaine & Opiates & etoh Heroin Synthetic & other opioids Alcohol & opiates Benzos & opiates

8 Drug Deaths: Wayne County, 2009 Heroin: 237 Cocaine: 223 Oxycodone: 35 Hydrocodone: 86 Fentanyl: 17 Methadone: 58 Other/unspecified: 58 Total: 665

9 IDEAS FOR ADDRESSING THIS EPIDEMIC Emerging Opioid Surveillance Group CSAT led bi-weekly conference calls including many state and federal agencies such as DEA, DOJ, State DOHs, CDC, FDA, CBOs, addiction, harm reduction, and public health professionals (and then some) County and area task forces Legal approaches state public health laws Single copy, serialized paper prescription forms MAPS prescription drug monitoring programs PDMP electronic data sharing Return of Unused Pharmaceuticals - Yellow Jug Doctor shopping statutes ED programs to manage frequent visitors P A U L O Z Z I, L. Naloxone distribution/harm reduction programming

10 1999

11 NYC SKOOP EVALUATION: JUNE- SEPTEMBER participants baseline interview 82% had seen an overdose 49% had ever overdosed Galea, Stancliff 2006

12 OVERDOSES ARE OFTEN WITNESSED: MANY OPIOID OVERDOSES ARE PREVENTABLE Fear of police may prevent calling 911 Abandonment is the worst response Witnesses may try ineffectual things first Salt & milk shots Tracy 2005

13 RESPONSES TO OVERDOSE: EDUCATION CAN BE A POWERFUL TOOL NYC SKOOP study Baseline n=19 Follow-up n=11 Called ambulance 58% 82% Took to hospital 5% 27% Injected with salt, water or cocaine 16% 0 Did nothing 21% 0 Mouth to mouth 5% 27%

14 SIGNS OF OVERDOSE, WHICH IS A LIFE THREATENING EMERGENCY, INCLUDE: Face is extremely pale and/or clammy to the touch i Body is limp Fingernails or lips have a blue or purple cast The patient is vomiting or making gurgling noises He or she cannot be awakened from sleep or is unable to speak Breathing is very slow or stopped Heartbeat is very slow or stopped.

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16 RESPONDING TO OVERDOSE In September 2008, WhoSoEver begins to address this issue in Michigan Naloxone kits prescribed to community members, opiate addicted people, and family members Prevention, Risk Reduction & SAVE ME County or area Prescription Drug Abuse Task Forces State Prescription Drug Abuse Task Force Narcotics Anonymous community State SUD conferences, 2009, 2010 Participation in EOOSG, since 2005 Participation in the NOPE workgroup National CSAT HIV grantee meetings 2010, Open Society Foundation community projects grantee

17 PROGRAM COMPONENTS Approved staff enroll people in the program and distribute naloxone Curriculum delivers education on OD prevention, recognition, and response Referral to detox and/or treatment Reports on overdose reversals are collected as enrollees return for refills Enrollment and refill forms submitted to physician s office Kits include instructions and 4 doses

18 VENUES Individual appointments/walk-ins through physician s practice Group presentations (i.e. parents groups) Trainings at the public library Narcotics anonymous meetings Limited outreach in larger cities Recovery Oriented Systems of Care Sheriff s Department in one rural county (nasal kits in cruisers)

19 OPIATE OVERDOSE FILM NIGHTS Community movie theatre Collaboration: Regional Hospital w SUD program; WhoSoEver; Project Lazarus; parents group; ASAM specialized Physician,Assistant Medical Examiner; recovering individuals

20 PRE 2014 AND POST 2014

21 New State-by-State Report Examines Growing Concern Over Prescription Drug Abuse Overdose deaths related to prescription drugs now outnumber those from heroin and cocaine combined, signaling a rapid rise in prescription drug abuse since A new report by Trust for America s Health, supported by the Robert Wood Johnson Foundation, highlights and scores states on 10 strategies states can use to address this epidemic. Twenty-eight states and Washington, D.C., scored six or less out of the 10 strategies. Two states, New Mexico and Vermont, are implementing all 10. South Dakota is using just two, the fewest of any state. The report calls for urgent action and provides recommendations for full-scale response to end this growing health threat. Use the interactive app to see how your state scored and view trends over time. Learn how your state scores on the 10 key steps to curb abuse.

22 Rx DRUG ABUSE: Michigan Approximately 6.1 million Americans abuse or misuse prescription drugs. Since 1999, overdose deaths involving prescription painkillers have quadrupled and now outnumber those from heroin and cocaine combined. Explore our application and find out how your state is tackling the prescription drug overdose epidemic. Learn which of the ten indicators your state has taken to reduce prescription drug abuse Michigan YES Existence of Prescription Drug Monitoring Program (PDMP) YES Doctor Shopping Law YES ID Requirement YES Prescriber Education Required or Recommended YES Pharmacy Lock-In Program No Good Samaritan Law No Mandatory Prescriber Use of PDMP No Support for Rescue Drug Use (Naloxone or Narcan) No Physical Exam Requirement No Substance Abuse Treatment Click a topic to learn more

23 WHY IT S IMPORTANT: THE NALOXONE LAW In areas where there is a lack of experience and or understanding of Naloxone, and its safety, or where there is continued inclination or practice of criminalizing drug use, doctors may be nervous to prescribe Naloxone because of liability issues that are not specific to Naloxone. Problems created because of the lax availability and misuse of prescription medication are fairly wellknown now. People (even medical personnel) may be nervous about this drug because of this, especially if they have not had the benefit of experience or knowledge of Naloxone, or naloxone distribution programming, and are unfamiliar with its safety.

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25 REDUCE THE STIGMA Talk about it!!! Information DOES NOT = enabling Denying access increases risk Open up the issue like any other Chance for intervention Discuss overdose information along with use/recovery/treatment etc., Listen and talk with users/nonusers/politicians/community

26 HELPFUL WEBSITES: Prescribetoprevent.org Overdosepreventionalliance.org Naloxoneinfo.org Stopoverdose.org Projectlazarus.org Whosoevercollaborative.org

27 Thank You

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